Manual medicine is as old as the science and art of medicine itself. Spinal manipulation in manual medicine is widely used as a treatment modality for spinal disorders. But one of the problems as perceived by the medical profession is that the therapy is often treated as a business rather than a science. In addition, its reputation has been blurred by some of its advocates claiming far too much for its effectiveness and using it as a panacea. Another observation is that many patients have been subjected to a prolonged and failed trial of spinal manipulation. It was written with one purpose in mind. The purpose is to give a basic overview of the present day practice and scope of the field of manual medicine. If, in addition, the information thus provided helps reduce certain existing prejudices toward this field.

Objective: The objective of this study is to determine the effect of unilateral brain lesion on hand strength and dexterity of ipsilateral side in hemiplegic patients and the change of strength and dexterity of ipsilateral hand after rehabilitation according to the side of brain lesion.

Method: Sixty four hemiplegic patients with unilateral brain lesion underwent hand function tests for the ipsilateral hand to the brain lesion. Grip strength, tip pinch, lateral pinch, and palmar pinch strength were measured, and Purdue pegboard test was performed. Results were compared with a group of forty age-matched healthy volunteers.

Results: There was significant decrement of hand strength and dexterity of ipsilateral side except grip strength in patients with unilateral brain lesion in the begining of rehabilitation compared with the controls. Hand strength and dexterity of ipsilateral hand was significantly improved after rehabilitation. There was no significant difference in hand strength and dexterity of ipsilateral side according to the side of hemispheric lesion.

Conclusion: Ipsilateral upper extremity function in hemiplegic patients may also be affected adversely, and therefore rehabilitation treatment for ipsilateral upper extremity function should be involved.

Objective: Fracture has been reported as one of complicated problems in stroke patients. The purpose of this study is to provide epidemiologic data on fractures in stroke patients and investigate the specific feature of these fractures.

Method: Stroke patients treated in Dong-Eui hospital due to fracture after stroke from March 1990 to March 1999 were enrolled in this study, and the retrospective study of fracture was performed on these patients.

Results: Subjects were 73 fracture patients with history of previous stroke. There were 50 patients with ischemic stroke and 23 patients with hemorrhagic stroke. And 35 patients were right hemiplegia, 38 patients were left hemiplegia. In this study, the causes of fracture were slip (63 cases, 86.3%), fall (6 cases, 8.2%), range of motion exercise (3 cases, 4.1%), and crushing injury (1 case, 1.4%). The frequency of fracture in patients who walk independently or with minimal to moderate assist was higher than in patients who walk with maximal assist or were bed-ridden state. In 65 patients, the fracture occured on the same side of hemiplegia. The distribution of fracture site was femur (45 cases, 61.6%), humerus (12 cases, 16.4%), and radius (3 cases) in the order of frequency. The interval between stroke and occurrence of fracture were less than 6 months in 34 cases (46.6%), 6 months to 1 year in 10 cases (13.7%), 1 to 2 years in 13 cases (17.8%), and 2 to 20 years in 16 cases (21.9%).

Conclusion: As with our study, the fracture in stroke patient tend to occur within the first year after a stroke as a result of slip and the most frequently affected site is femur of hemiplegic side.

Objective: The purpose of this study is to determine clinical and phonological characteristics of the patients with specific language impairment (SLI).

Method: Subjects were 24 SLI patients without known mental retardation, cerebral palsy, epilepsy, hearing loss or structural brain lesion and 23 normal children. Developmental history, oropharyngeal abnormality, and brainstem auditory evoked potentials were obtained in SLI patients. Receptive language age and quotient were assessed by Peabody picture vocabulary test. Phonetic characteristics of subjects were analysed using Visi-Pitch^Ⱂ and computerized speech laboratory.

Results: In perceptual evaluation, 32.3% of SLI patients showed incomplete articulation pattern. The patterns of incomplete articulation were substitution, distortion, nasalization, and addition. The receptive language of SLI patients (0.89⁑0.28) was significantly lower than control group (1.16⁑0.18). In Visi-Pitch^Ⱂ analysis, diadochokinetic rate and maximal phonation time were decreased in SLI patients. The total duration of three syllables in SLI patients were significantly prolonged, especially for bilabial heavily asperated and glottalized consonants and alveolar and velar slightly asperated, heavily asperated, and glottalized consonants.

Conclusion: The patients with SLI showed characteristic defect in articulation as well as expressive and receptive language delayment. This articulatory defect may be resulted from disturbance of central programming and coordination of articulation. The objective and quantitative analysis of Phonological characteristics using computerized speech system in SLI patients can contribute to diagnose and evaluate the treatment outcome for the patients.

Objective: The purpose of this study was to evaluate the clinical effectiveness of intravesical oxybutynin chloride instillation in the management of neurogenic bladder dysfunction in spinal cord injured patients.

Method: Fifty-two spinal cord injured patients with hyperreflexic or hypertonic neurogenic bladder were treated with intravesical oxybutynin instillation therapy. The purified oxybutynin chloride was dissolved in sterile water and mixed with normal saline. This oxybutynin solution was instilled twice a day for 7 days. The urodynamic studies were compared before and after the instillation. Total volume of daily incontinence was also monitored.

Results: After the intravesical oxybutynin instillations, mean maximal bladder capacity increased from 212.13 to 323.81 ml (p＜0.01), mean bladder compliance increased from 11.73 to 18.56 ml/cmH₂O (p＜0.01), mean maximal detrusor pressure decreased from 67.19 to 50.90 cmH₂O (p＜0.01) and mean daily amount of incontinence decreased from 735.58 to 201.73 ml (p＜0.01). No significant differences were found between the groups according to the level of injury, completeness of injury, duration since onset of injury and the presence of asymptomatic bacteriuria.

Conclusion: This study proved that intravesical instillation of oxybutynin solution is an effective method in spinal cord injured patients with hyperreflexic or hypertonic neurogenic bladder dysfunction regardless the level and completeness of injury, as well as duration since the onset of injury or the presence of asymptomatic bacteriuria.

Objective: To investigate the autonomic activities in spinal cord injured patients, and to compare their activities according to the level and completeness of spinal cord lesions.

Method: Thirty-five spinal cord injured patients and thirty healthy adults participated in this study. The ECG signals were recorded at the tilt angle of 0^o and 70^o for 5 minutes, and power spectral analysis of Heart Rate Variability (HRV) was done at each angle.

Results: The data reveals two major components such as a low-frequency (LF) component (0.05∼0.15 Hz) reflecting primarily sympathetic activities with orthostatic stress, and a high- frequency (HF) component (0.2∼0.3 Hz) reflecting parasympathetic activity. In supine position, all frequency components were not significantly different regardless the level and completeness of spinal cord lesion. At 70^o head-up tilt position, the LF power and heart rate didn't increase in complete tetraplegia but significantly increased in paraplegia and healthy adults (p＜0.05). However, the HF power didn't reveal any differences in four groups by decreasing significantly in all groups.

Conclusion: We concluded that there is an abnormal control of autonomic activities especially the sympathetic function in complete tetraiplegia, compared with paraplegia and healthy adults.

Objective: To collect the informations of the traumatic spinal cord injury persons in Suwon city.

Method: Seventy-five traumatic spinal cord injury persons were evaluated by the neurological level, American Spinal Injury Association scale, Functional Independence Measure (FIM), Craig Handicap Assessment and Reporting Technique (CHART), Beck Depression Inventory (BDI), and questionnaire on their voiding methods, complications, etc.

Results: The leading cause of 75 persons with traumatic spinal cord injury was a traffic accident. Among them, paraplegics were 46 persons. The most common complication was a pressure sore which was also the leading cause of their rehospitalization. Twenty-six persons voided by reflex. Among five dimensions of CHART, the physical independence score was the highest and the economic self sufficiency score was the lowest. The total CHART scores were significantly correlated with BDI scores, FIM scores, and level of injury.

Conclusion: This study revealed that physical impairment, disability and depression affect the handicaps of spinal cord injury persons. These data could be used to develop a social rehabilitation program for the spinal cord injury persons in the community.

Objective: Patients with carpal tunnel syndrome are often refered for electrophysiologic evaluation of postoperative residual symptoms. We performed this prospective study to assess changes of the electrophysiological parameters after carpal tunnel release.

Method: Fifty-four hands of 29 patients with electrodiagnostically confirmed carpal tunnel syndrome underwent surgical release of the transverse carpal ligament. Serial electrophysiological evaluation of the median nerve performed at 2 weeks, and 1, 3, 6 months after surgery in all patients. All the tests were performed by one electromyographer using Dantec Counterpoint machine. Median motor and sensory responses were obtained from abductor pollicis brevis and 3rd digit respectively. Repeated measure ANOVA test was done to observe the changes in each parameter on serial examination.

Results: The median motor latency (ML), motor amplitude (MA), sensory latency (SL) and sensory amplitude (SA) were as follows: preoperative ML (6.1⁑0.2 ms), MA (7.3⁑0.5 mV), SL (5.1⁑0.2 ms), SA (6.8⁑1.0 uV); postoperative week 2, ML (5.5⁑0.2 ms), MA (6.9⁑0.5 mV), SL (4.5⁑0.2 ms), SA (11.4⁑1.3 uV); postoperative month 1, ML (5.1⁑0.2 ms), MA (7.1⁑0.5 mV), SL (4.1⁑0.2 ms), SA (13.0⁑1.3 uV); month 3, ML (4.6⁑0.1 ms), MA (7.2⁑0.1 mV), SL (3.8⁑0.2 ms), SA (15.4⁑1.4 uV); month 6, ML (4.6⁑0.2 ms), MA (7.4⁑0.5 mV), SL (3.5⁑0.1 ms), SA (16.5⁑1.4 uV).

Conclusion: Improvement was gradually seen up to the postoperative 3 months. However, the least amount of improvement was observed in the postoperative 3 to 6 month period.

Objective: To investigate waveform changes of compound muscle action potentials (CMAPs) related to voluntary muscle contraction and alteration of muscle length and to evaluate the effect of peripheral neuropathy on temporal and spatial summations of CMAPs.

Method: The influence of voluntary muscle contraction and alteration of muscle length on CMAP was studied in 37 median nerves of 21 patients with median neuropathy.

Results: In patients with no apparent axonopathy, temporal summation was partially disturbed without significant change of spatial summation. Shortening of muscle length or voluntary contraction produced a physiologic improvement of spatial and temporal summations. There was a decrease in temporal and spatial summations, more prominent in temporal summation, with lengthening of the muscle. In axonopathy, spatial summation was markedly deteriorated with partial reduction of temporal summation. Spatial summation was not affected by the change of muscle length or voluntary contraction. Temporal summation was improved by muscle shortening or voluntary contraction and was decreased by muscle lengthening.

Conclusion: Peripheral neuropathy has an effects on physiological spatial and temporal summations of CMAPs. Temporal summation is preferentially decreased in cases without axonopathy. When axonopathy is apparent, spatial summation is profoundly disturbed with partial reduction of temporal summation.

Objective: To identify the existence of ipsilateral responses by magnetic stimulation, and to elucidate the influences of ipsilateral tonic contraction on bilateral MEP responses, and to attain the proper facilitation technique for bilateral MEP responses.

Method: Ten normal healthy volunteers who were right handed, were recruited. They performed the voluntary contraction of thenar muscle via lateral prehension with three stage, contralateral, bilateral, ipsilateral contraction by 70 mm bipolar coil stimulator (figure-of-eight shaped). The excitability threshold (ET) at rest was determined, and then, three facilitation techniques with combination of both voluntary contraction and stimulus intensity were also performed: A technique, minimal facilitation (10% of MVC) with ET intensity; B technique, moderate facilitation (30% of MVC) with 110% of ET intensity; C technique, minimal facilitation (10% of MVC) with 140% of ET intensity. Contralateral, bilateral and ipsilateral voluntary contractions were performed in each technique. In 90 mm circular coil stimulator, same procedure as above was followed.

Results: There were no differences of ET between the two coil stimulators. Ipsilateral MEP responses were not detected after bipolar coil stimulation except one case in C technique, but they were developed over 70% in B and C technique with ipsilateral muscle contraction. However, only 2 cases of ipsilateal responses could be detected in C technique, and not detected in A and B technique. The latency of ipsilateral responses were similar to that of contralateral responses, but the amplitude was much lower than that of contralateral responses. Ipsilateral muscle contraction reduced the amplitude of contralateral MEP in moderate facilitation (B technique). Especially, ipsilateral response was never evoked in B technique with contralateral contraction.

Conclusion: In normal subjects, ipsilateral MEPs can't be obtained in focal magnetic stimulation. Ipsilateral tonic contractions are regarded as reducing facilitative effects of contralateral MEP responses. Bilateral responses should be attained when contralateral target muscle is contracted with moderate facilitation (30% of MVC and 110% of threshold intensity). In this facilitation, the stimulation by circular coil is no less effective than focal stimulation by 70 mm bipolar.

Objective: To evaluate the clinical and electrodiagnostic findings of ulnar neuropathy at the elbow.

Method: Sixty-two patients with ulnar neuropathy at the elbow were reviewed retrospectively to establish causes, severity and type of neuropathy, symptom, sign, operation name and operative findings.

Results: 1) Of total 62 cases, 41 were male and 21 were female and the most often were in their forties and fifties. 2) The main cause of the neuropathy is bone deformity caused by previous fracture or dislocation (43.6%). 3) The symptoms observed were motor weakness (66.1%), sensory change (79%) and muscle atrophy (35.5%). 4) Forty-nine cases showed abnormality in nerve conduction study and needle electromyography study, and 9 cases showed abnormality only in the needle electromyography study. 5) On needle electromyography, sparing of flexor carpi ulnaris was shown in 50 cases (80.6%). 6) Operative treatment was performed in 15 cases. Among them, electrodiagnostic and operative diagnosis coincided in only 12 cases (80%).

Conclusion: We conclude that above clinical and electrodiagnostic findings are useful for the diagonosis ulnar neuropathy at the elbow with consideration of etiology, localization and for the selection of operative treatment.

Objective: Distance between the active and reference electrodes can affect the waveform configuration and amplitude of sensory nerve action potential (SNAP). This study was purposed to determine the change of SNAP parameters with varying interelectrode distance.

Metohod: Median sensory nerve conduction study was performed in the middle finger of 40 young healthy subjects by antidromic method. To ensure firm contact with skin, strip adhesive electrode was used for recording responses. The active electrode was fixed on 1 cm distal to the proximal flexion crease of middle finger and interelectrode separation was increased from 1 to 5 cm by 1.0 cm increments. Bar electrode was fixed 14 cm proximal from active electrode for stimulation in the wrist area.

Results: As the interelectrode distance increased from 1 cm to 5 cm, onset latency remained unchanged. The peak latency increased with increasing the distance up to 3 cm but didn't change beyond 3 cm (1 cm: 2.89⁑0.89 msec, 2 cm: 2.97⁑0.89 msec, 3 cm: 3.02⁑0.19 msec, 4 cm: 3.02⁑0.19 msec, 5 cm: 3.02⁑0.20 msec). Base-to-peak amplitude significantly increased only up to 3 cm (1 cm: 30.3⁑6.7μV, 2 cm: 43.7⁑8.6μV, 3 cm: 50.8⁑10.4μV, 4 cm: 51.1⁑10.9 μV, 5c m: 51.3⁑11.4μV) but peak-to-peak amplitude sequentially increased to 5 cm (1 cm: 49.6⁑12.1μV, 2 cm: 72.8⁑14.4μv, 3 cm: 83.6⁑19.4μV, 4 cm: 91.3⁑22.5μV, 5 cm: 93.4⁑23.9μV)(p＜.05).

Conclustion: This study showed that changing interelectrode distance altered some parameters of SNAP, especially the peak-to peak amplitude.

Objective: To investigate the influence of high frequency transcutaneous electrical nerve stimulation (TENS) on cutaneous silent period.

Method: Cutaenous silent period was recorded before and after high frequency TENS application in sixteen healthy adults (11 males, 5 females). Onset latency, duration, and minimum stimulation intensity to evoke cutaneous silent period were compared. In 7 male subjects, temporal changes of cutaneous silent period were observed after TENS application.

Results: Minimum stimulation intensity to evoke cutaneous silent period was significantly increased after high frequency TENS application (p＜0.05) and yet, onset latency and duration showed no significant change. The increase in minimum stimulation intensity to evoke cutaneous silent period was maintained for 30 minutes after TENS and returned to the baseline level thereafter.

Conclusions: These results suggest that high frequency TENS increase the depolarization threshold of A-δ fiber and this peripheral effect may be one of the pain control mechanisms of TENS.

Objective: Absolute or relative increase in the latency of the major surface positive component is almost invariably found in patients with demyelination optic neuropathy. Using the pattern- reversal method, our study illustrates the significant changes in the latency of the P100 component when refractive errors are introduced to defocus in normal person.

Method: Four women and ten men aged 20 to 27 years were selected after a thorough ophthalmological assessment. Visual acuity (VA) was 6/6 or better in all subject and none had dyschromatopsia or significant astigmatism. Refractive errors were created by the combined standard lenses.

Results: The mean value of P100 latency were as follows: 93.74⁑3.30 msec, naked eyes; 98.14⁑7.37 msec, the ⁢2/⁢⁓90 lens; 96.50⁑3.76 msec, the ⁢1/⁢1⁓90 lens; 94.55⁑4.20 msec, the ⁣1/⁣1⁓90; 96.29⁑2.88 msec, the ⁣2/⁣2⁓90 lens. The P100 latencies showed singnificant standard lens except with ⁣1/⁣1⁓90 lens. The P100 latency was prolonged according to the progression of refractive error.

Conclusion: Because a relative or absolute prolongation of P100 latency is often found in cases of suspected multiple sclerosis, and because of their similarity to the findings of our study, we would emphasize that refractive errors should be reduced or eliminated to minimize the false-positive results.

Objective: To investigate the pattern of exon deletions in Korean patients with Duchenne muscular dystrophy (DMD), and to find the correlation of the exon-deletion with clinical symptoms or laboratory findings.

Method: Genomic DNA of the nine children with DMD were analyzed by the sets of multiplex PCR and one singlet PCR in total of fifteen primers of the dystrophin gene. The primers were made from the promotor, and the exons 3, 4, 6, 8, 12, 13, 43, 44, 47, 48, 50, 51, 52 and 60 of the dystrophin gene, respectively.

Results: Eight out of nine patients revealed exon deletions. The exon 3 was most commonly deleted (6 patients), and exon 48, 50 and 60 were second most common (2 patients). The exons 4, 6, 13, 44, 47 and 52 were not deleted in all patients.

Conclusion: We found that the exons 3, 48, 50 and 60 are frequently deleted in Korean patients with DMD. The pattern of deletion was not correlate with clinical symptoms or laboratory findings.

Objective: To assess the significance of anti-type I collagen antibody titer in estimating cumulative trauma and predicting the presence of occupational low back pain.

Method: Under the hypothesis that cumulative trauma on the spine will expose collagen and stimulate the formation of auto-antibody, we measured the serum anti-type I collagen antibody titers (IgM and IgG) in 408 male workers of a metal welding and manufacturing company. The antibody titers were measured in duplicates by ELISA. Statistical analysis was done to compare the titers according to occupational profiles (type of occupation and duration of employment) and clinical profiles (occurrence of low back pain, duration of low back pain and clinical impression).

Results: The anti-type I collagen IgG antibody titers were significantly increased in labor workers (n=357) in comparison with office workers (n=51)(p＜0.05). Among the labor workers both IgM and IgG antibody titers were increased in the low back pain group (n=50) though it did not reach statistical significance (p-value of IgM antibody titers=0.07). IgM and IgG antibody titers were increased in the chronic low back pain group (≥3 months)(n=8).

Conclusion: These data suggest that anti-type I collagen IgM and IgG antibody may be useful in predicting the presence of occupational low back pain and estimating cumulative trauma, respectively.

Objective: To evaluate the efficacy of epidural injections of steroid and local anesthetics with the modified Dallas pain questionnaire in the low back pain patients.

Method: Before and after epidural injections with triamcinolone and local anesthetics, we examined the patients with modified Dallas pain questionnaire. The efficacy was assessed by paired t test to compare the results of this questionnaire.

Results: Four aspects of the patient's life (daily activity, work and leisure activity, anxiety- depression, and social interest) were significantly improved after epidural injection in low back pain patients. And their improvements were more definite in patients diagnosed with herniatied lumbar disc, relatively acute onset of symptom, and more serious findings in MRI.

Conclusion: Epdiural injections of steroid and local anesthetics are effective for patients with low back pain, espercially for improving life quality of patients such as daily activity and work-leisure activity. It also decreases anxiety and increases social interest in some patients. However, validity of modified Dallas pain questionnaire must be proved in the future.

Objective: To assess the clinical manifestation of acute herpes zoster associated pain (AHP) and postherpetic neuralgia (PHN) and nerve block effect in AHP and PHN.

Method: We assessed twenty eight patients by physical examination and pain questionairre, and nerve block effect in thirty one patients. We injected local anesthetics and triamcinolone into nerve root or trunk in study group, and saline in control group. The effect was assessed by visual analogue scale.

Result: 1. Clinical manifestation: There was high incidence in thoracic dermatome. AHP and PHN patients expressed "sharp" pain. Pain rating index of AHP and PHN were 32.9, 33.0. 2. Nerve block effect: There was no nerve block effect in AHP (p＞0.05) and PHN (p＞0.05), but four patients of PHN patients in study group had significant pain relief, who suffered from pain during 2 month, 10 month, 6 years, 8 years.

Conclusion: AHP and PHN had variable clinical manifestation but no difference between them. There was no nerve block effect in AHP and PHN but we can consider nerve block as a additive method for pain relief of PHN because some patients responded to nerve block and there was no significant complication in nerve block.

Objective: To evaluate the effect of compensation or secondary gain on the pain behavior and psychometric characteristics.

Method: We examined 88 patients who complained of chronic low back pain by the various pain questionnaires, electrodiagnostic study and magnetic resonance imaging (MRI). Total patients were classified into two groups (46 patients who wanted disability evaluation and 42 patients who did not).

Results: Mean score of visual analogue scale, total sum of McGill pain questionnaire and pain rating index on sensory, affective and miscellaneous dimensions were significantly higher in patients related to disability compensation than those in patients without compensation. Mean scores of pain disability index and symptom checklist-90-revision were significantly higher on various subclass in patients with compensation. Various pain scales were significantly correlated to each other in both group but the severity of electrodiagnostic study and MRI findings were not related with the degree of pain index score in both group.

Conclusion: Compensation or secondary gain affect pain behavior and psychometric characteristics in chronic low back patients. So when we evaluate or treat the patients with chronic low back pain, we should consider above results.

Objective: To determine the relationship between magnetic resonance imaging (MRI) and discography in visualization of disc degeneration.

Method: Forty-eight patients with suspected discogenic pain in lumbar spines and degenerative changes of the lumbar intervertebral discs in T2-weighted magnetic resonance imaging were studied. Five types of discogram (cottonball, lobular, irregular, fissured, and ruptured) were classified by identifiable features in shape and density of radio-opaque shadow. Three types of MRI (bulging, protrusion, and extrusion) were classified by degrees of disc herniation. The correlation between two imaging techniques of lumbar intervertebral discs were analyzed using Spearman's correlation coefficient.

Results: Of sixty-three discs, MRI finding of the disc herniation revealed as follows: bulging, 17 discs; protrusion, 20 discs; extrusion, 26 discs. Discography revealed as follows: cottonball, 15 discs; lobular, 2 discs; irregular, 11 discs; fissured, 10 discs; ruptured, 25 discs. 46 discs of 63 discs showed internal structural abnormalities (irregular, fissured, or ruptured). There was no statistically significant correlation between MRI and discography in visualization of the disc degeneration (r=0.081).

Conclusion: Severity of the lumbar intervertebral disc degeneration in MRI was not correlated with degenerative severity of discographic imaging. Supplementary discography may be useful in evaluation of patients with discogenic pain since discographic imaging when compared to MRI visualizes disc degeneration more accurately.

Objective: The purpose of this study was to evaluate the whole spine of the patients with chronic low back pain.

Method: The cervico-thoraco-lumbar spine were evaluated in 128 patients with chronic low back pain. We analyzed radiologic and clinical findings of the cervico-lumbar spine and electrodiagnostic findings.

Results: Most of all cases showed abnormal findings in plain radiography and electrodiagnostic study. The radiologic findings were as follow: cervical X-ray with straightening of cervical lordotic curve in 85 cases; thoracic X-ray with scoliosis in 55 cases; lumbar X-ray with disc space narrowing in 85 cases. The electrodiagnostic study revealed lumbosacral radiculopathy in 87 cases. There were significant positive relationship between increased lumbosacral angle and straightening of cervical lordotic curve, and between lumbar scoliosis and thoracic scoliosis.

Conclusion: Cervico-thoracic spinal abnormalities were shown in most of the patients with chronic low back pain. Therefore, The evaluation of whole spine would be needed comprehensive rehabilitation approach for the patients with chronic low back pain.

Objective: To investigate the cross-sectional association of the obesity with the knee osteoarthritis (OA) in a rural population.

Method: We studied the cross-sectional asssociation between the obesity and the knee OA by analysis of data (Juam-Study based data) from an epidemiologic survey of a population of 1,100 adults who resided around the Juam lake in Chonnam. The recruited sampling were 475 adults above 40 years old. We diagnosed knee OA by typical clinical features such as bony swelling, crepitus and pain on movement and divided the subjects into non-OA group (143 males：148 females) and OA group (60 males：124 females). There is no difference in the mean ages of two groups. The body mass index (BMI) was calculated from a weight and height (kg/m²) and body fat percent (BFP) was measured by bioelectric impedance fatness analyzer (BIA). We defined obesity as a BMI over 30 kg/m² in both sex or a BFP over 25% in male and over 30% in female. The BMI and BFP were 23.2⁑3.2 kg/m², 24.0⁑7.5% in non-OA group and 23.5⁑3.4 kg/m², 26.0⁑7.0% in OA group and were compared in two groups.

Results: 1) Prevalence odds ratio (POR) for risk factors of knee OA was high in seventh decade, female, a high cholesterol group, and a high BFP group, and was not high in BMI group. 2) There was no association between BMI and knee OA. 3) There was no association between BFP and knee OA.

Conclusion: We were not able to prove the cross-sectional association between obesity and knee OA. The results suggested that knee OA was a heterogeneous disorder and more possibly influenced by multiple other factors, such as age, sex, and various metabolic abnormalities than obesity itself.

When recovery of specific reflexes after acute spinal cord injury are delayed or absent, we should consider an acute local complication or other factors that influence reflex function. We observed three spinal cord injury cases with a long-standing delayed plantar reflex and no evolution of Babinski sign despite enough recovery time had passed for the flexor spasm and all deep tendon reflexes of the lower extremities. In these cases we confirmed common peroneal nerve neuropathy at the fibular head by the nerve conduction study and electromyography. Long-standing delayed plantar reflex without evolution of Babinski sign, beyond expected recovery period, would be considered as a sign of local complication such as common peroneal nerve injury.

In spinal cord injury, various options exist for the management of the neurogenic bladder. For the management of neurogenic bladder, urethral stent was placed under a cystoscopic guidance as one day procedure. Urethral stents were inserted in a T12 spinal cord injured patient who had recurrent urinary tract infections and a vesicoureteral reflux (VUR) and a T3 spinal cord injured patient who had a detrusor-sphincter dyssynergia. In the first case, recurrent urinary tract infection and VUR were resolved after the stenting. In the second case, urethral stent was removed because of the failure of continuous drainage. Because of its easily reversible nature, the urethral stent can be adopted for use in pateints as an option of neurogenic bladder management.

Spontaneous hematomyelia (intramedullary spinal hematoma) is an uncommon event of an unknown cause. A 35-year-old man experienced sudden paresthesia over the chest, radiating pain, and motor weakness followed by complete paraplegia appeared after 1 hour. The preoperative diagnosis was made by magnetic resonance imaging which revealed hemorrhages from T4 to T9 cord segments. The selective spinal angiography, CSF study, blood laboratory, and pathology revealed no apparent cause for the hemorrhages.

Essential osteolysis is very rare, slowly progressive disease. Its etiology and pathophysiology is still unknown. Only one case has been reported in Korea.

We experienced one case of essential osteolysis associated with renal insufficiency involving bilateral carpal, metacarpal, tarsal, metatarsal bones, elbow, ankle.

We report a case of 24-year-old female who had manifestations of essential osteolysis with renal insufficiency with brief review of literatures.